The Intrapartum and Postpartum Care of Women Following Assisted Reproduction Techniques (ART)

  • Sonia AsifEmail author
  • Srini Vindla


Pregnancies conceived through ART are significantly more complex than those resulting from spontaneous conception. They should be considered at a higher risk of complications in the intrapartum and postnatal period. The multifactorial nature of infertility both voluntary and involuntary has led to women being older at the outset of their first pregnancy, with a higher incidence of comorbidities including obesity, hypertension and diabetes. This has further implications for labour and the puerperium. From a healthcare perspective, there is an emerging trend of both obstetricians and midwives viewing patients who conceive through ART as carrying “precious” pregnancies. This protective attitude is especially evident in older women who may have had multiple attempts to conceive and achieving another pregnancy may prove challenging. The concern about minimising adverse fetal outcomes and fear of litigation leads to medical staff having a lower threshold for intervening earlier and offering induction of labour/operative delivery. The mental well-being and psychological coping strategies of women who conceive with ART are also different from spontaneously conceived pregnancies. The emotionally demanding aspects of fertility treatment positively prepare some women to deal with the unexpected complications of childbirth whereas for others these same factors can lead to anxiety about delivery. Fertility specialists must ensure that that they maximise maternal health before offering In vitro fertilisation (IVF) treatment and continue to reduce the multiple pregnancy rate. Robust referral pathways and timely communication between IVF units and antenatal services is pivotal to highlighting and triaging the obstetric needs of these patients. Seamless multidisciplinary involvement with maternal medicine physicians and mental health services where appropriate will further empower patients to lead a smoother course in their pregnancies.


Obstetric care Pregnancy complications Labour Breastfeeding Psychological impact ART 


  1. 1.
    Human Fertilisation and Embryology Association. The HFEA guide to infertility 2007/08. London: HFEA; 2007.Google Scholar
  2. 2.
    Joels L, Wardle P. Assisted conception and the midwife. Br J Midwifery. 1994;12(9):429–35.Google Scholar
  3. 3.
    Morgan J. The assisted conception pregnancy. Pract Midwife. 2004;7(8):18.PubMedGoogle Scholar
  4. 4.
    Hjelmstedt A, et al. Patterns of emotional responses to pregnancy, experience of pregnancy and attitudes to parenthood among IVF couples: a longitudinal study. J Psychosom Obstet Gynaecol. 2003;24(3):153–62.CrossRefPubMedGoogle Scholar
  5. 5.
    Younger M, Hollins-Martin C, Choucri L. Individualised care for women with assisted conception pregnancies and midwifery practice implications: an analysis of the existing research and current practice. Midwifery. 2015;31(2):265–70.CrossRefPubMedGoogle Scholar
  6. 6.
    Windridge KC, Berryman JC. Women’s experiences of giving birth after 35. Birth. 1999;26(1):16–23.CrossRefPubMedGoogle Scholar
  7. 7.
    Hammarberg K, Fisher JR, Rowe HJ. Women’s experiences of childbirth and post-natal healthcare after assisted conception. Hum Reprod. 2008;23(7):1567–73.CrossRefPubMedGoogle Scholar
  8. 8.
    Bryan A. The psychosocial effects of infertility and the implications for midwifery practice. MIDIRS Midwifery Dig. 2000;10(1):8–12.Google Scholar
  9. 9.
    Poikkeus P, et al. Birth experience of women conceiving with assisted reproduction: a prospective multicenter study. Acta Obstet Gynecol Scand. 2014;93(9):880–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Rouhe H, et al. Fear of childbirth according to parity, gestational age, and obstetric history. BJOG. 2009;116(1):67–73.CrossRefPubMedGoogle Scholar
  11. 11.
    Hjelmstedt A, et al. Emotional adaptation following successful in vitro fertilization. Fertil Steril. 2004;81(5):1254–64.CrossRefPubMedGoogle Scholar
  12. 12.
    National Institute for Health and Clinical Excellence. Guidance on antenatal care for uncomplicated pregnancies (CG62). 2008.Google Scholar
  13. 13.
    Helmerhorst FM, et al. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ. 2004;328(7434):261.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Jackson RA, et al. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol. 2004;103(3):551–63.CrossRefPubMedGoogle Scholar
  15. 15.
    Marino JL, et al. Perinatal outcomes by mode of assisted conception and sub-fertility in an Australian data linkage cohort. PLoS One. 2014;9(1):e80398.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Koudstaal J, et al. Obstetric outcome of singleton pregnancies after IVF: a matched control study in four Dutch university hospitals. Hum Reprod. 2000;15(8):1819–25.CrossRefPubMedGoogle Scholar
  17. 17.
    National Institute for Health and Clinical Excellence. Guidance on Hypertension in pregnancy:diagnosis and management (CG107). 2011.Google Scholar
  18. 18.
    National Institute for Health and Clinical Excellence. Guidance on diabetes in pregnancy: management from preconception to the postnatal period (NG3). 2015.Google Scholar
  19. 19.
    National Institute for Health and Clinical Excellence. Guidance on multiple pregnancy-antenatal care of twin and triplet pregnancies (CG129). 2011.Google Scholar
  20. 20.
    Royal College of Obstetricians and Gynaecologists. RCOG guideline on placenta praevia, accreta and vasa praevia with the national patient safety agency care bundle for the management of placenta praevia after previous Caesarean section-green top guideline 27. London: RCOG; 2011.Google Scholar
  21. 21.
    Walker KF, et al. Induction of labour versus expectant management at term by subgroups of maternal age: an individual patient data meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016;197:1–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Koopmans CM, et al. Induction of labour versus expectant monitoring in women with pregnancy induced hypertension or mild preeclampsia at term: the HYPITAT trial. BMC Pregnancy Childbirth. 2007;7(1):14.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Royal College of Obstetricians and Gynaecologists. RCOG guideline on antenatal steroids to reduce neonatal morbidity and mortality -green top guideline 7. London: RCOG; 2010.Google Scholar
  24. 24.
    Ashrafi M, et al. Risk of gestational diabetes mellitus in patients undergoing assisted reproductive techniques. Eur J Obstet Gynecol Reprod Biol. 2014;176:149–52.CrossRefPubMedGoogle Scholar
  25. 25.
    Cunningham FG. Williams obstetrics. 23rd ed. New York: McGraw-Hill; 2010. p. 1385.Google Scholar
  26. 26.
    Royal College of Obstetricians and Gynaecologists. RCOG guideline on shoulder dystocia -green top guideline 42. London: RCOG; 2012.Google Scholar
  27. 27.
    Human Fertilisation and Embryology Association. Fertility treatment in 2013: trend and figures. London: HFEA; 2013.Google Scholar
  28. 28.
    Caserta D, et al. Maternal and perinatal outcomes in spontaneous versus assisted conception twin pregnancies. Eur J Obstet Gynecol Reprod Biol. 2014;174:64–9.CrossRefPubMedGoogle Scholar
  29. 29.
    McDonald S, et al. Perinatal outcomes of in vitro fertilization twins: a systematic review and meta-analyses. Am J Obstet Gynecol. 2005;193(1):141–52.CrossRefPubMedGoogle Scholar
  30. 30.
    Barrett JF, et al. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med. 2013;369(14):1295–305.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Royal College of Obstetricians and Gynaecologists. RCOG guideline on thrombosis and embolism during pregnancy and the puerperium, reducing the risk-green-top guideline No. 37a. London: RCOG; 2009.Google Scholar
  32. 32.
    National Institute for Health and Clinical Excellence. Guidance on intrapartum care in healthy women and babies (CG190). 2014.Google Scholar
  33. 33.
    Cox SJ, et al. Maternal self-esteem after successful treatment for infertility. Fertil Steril. 2006;85(1):84–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Greenfeld D, Caruso KS. Transition to parenthood among in vitro fertilization patients at 2 and 9 months postpartum. Fertil Steril. 2001;76(3):626–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Fisher JR, Hammarberg K, Baker HW. Assisted conception is a risk factor for postnatal mood disturbance and early parenting difficulties. Fertil Steril. 2005;84(2):426–30.CrossRefPubMedGoogle Scholar
  36. 36.
    Listijono DR, Mooney S, Chapman M. A comparative analysis of postpartum maternal mental health in women following spontaneous or ART conception. J Psychosom Obstet Gynaecol. 2014;35(2):51–4.CrossRefPubMedGoogle Scholar
  37. 37.
    Labbok MH. Effects of breastfeeding on the mother. Pediatr Clin North Am. 2001;48(1):143–58.CrossRefPubMedGoogle Scholar
  38. 38.
    Barnes M, et al. Experiences of birth and breastfeeding following assisted conception. Breastfeed Rev. 2013;21(1):9–15.PubMedGoogle Scholar
  39. 39.
    Fisher J, et al. Assisted conception, maternal age and breastfeeding: an Australian cohort study. Acta Paediatr. 2013;102(10):970–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Difrisco E, et al. Factors associated with exclusive breastfeeding 2 to 4 weeks following discharge from a large, urban, academic medical center striving for baby-friendly designation. J Perinat Educ. 2011;20(1):28–35.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Fisher JR, Hammarberg K, Baker GH. Antenatal mood and fetal attachment after assisted conception. Fertil Steril. 2008;89(5):1103–12.CrossRefPubMedGoogle Scholar
  42. 42.
    Hammarberg K, et al. Breastfeeding after assisted conception: a prospective cohort study. Acta Paediatr. 2011;100(4):529–33.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Division of Obstetrics, Gynaecology, and Child HealthQueens Medical CentreNottinghamUK
  2. 2.Department of Obstetrics and GynaecologySherwood Forest Hospitals NHS Foundation TrustSutton-In-AshfieldUK

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